TY  - JOUR
A1  - Lapa, Constantin
A1  - Werner, Rudolf A.
A1  - Bluemel, Christina
A1  - Lueckerath, Katharina
A1  - Muegge, Dirk O.
A1  - Strate, Alexander
A1  - Haenscheid, Heribert
A1  - Schirbel, Andreas
A1  - Allen-Auerbach, Martin S.
A1  - Bundschuh, Ralph A.
A1  - Buck, Andreas K.
A1  - Herrmann, Ken
T1  - Prediction of clinically relevant hyperkalemia in patients treated with peptide receptor radionuclide therapy
T2  - EJNMMI Research
N2  - Background
Peptide receptor radionuclide therapy (PRRT) is applied in patients with advanced neuroendocrine tumors. Co-infused amino acids (AA) should prevent nephrotoxicity. The aims of this study were to correlate the incidence of AA-induced hyperkalemia (HK) (≥5.0 mmol/l) and to identify predictors of AA-induced severe HK (>6.0).

Methods
In 38 patients, standard activity of \(^{177}Lu\)-labelled somatostatin analogs was administered. Pre-therapeutic kidney function was assessed by renal scintigraphy and laboratory tests. For kidney protection, AA was co-infused. Biochemical parameters (potassium, glomerular filtration rate, creatinine, blood urea nitrogen (BUN), sodium, phosphate, chloride, and lactate dehydrogenase (LDH)) were obtained prior to 4 and 24 h after the AA infusion. Incidence of HK (≥5.0) was correlated with pre-therapeutic kidney function and serum parameters. Formulas for the prediction of severe hyperkalemia (>6.0) were computed and prospectively validated.

Results
At 4 h, HK (≥5.0) was present in 94.7% with severe HK (>6.0) in 36.1%. Values normalized after 24 h in 84.2%. Pre-therapeutic kidney function did not correlate with the incidence of severe HK.

Increases in K+ were significantly correlated with decreases in phosphate (r = −0.444, p < 0.005) and increases in BUN (r = 0.313, p = 0.056). A baseline BUN of >28 mg/dl had a sensitivity of 84.6% and a specificity of 60.0% (AUC = 0.75) in predicting severe HK of >6.0 (phosphate, AUC = 0.37).

Computing of five standard serum parameters (potassium, BUN, sodium, phosphate, LDH) resulted in a sensitivity of 88.9% and a specificity of 79.3% for the prediction of severe HK >6.0 (accuracy = 81.6%).

Conclusions
A combination of serum parameters predicted prospectively the occurrence of relevant HK with an accuracy of 81.6% underlining its potential utility for identifying ‘high-risk’ patients prone to PRRT.
KW  - amino acids
KW  - kidney function
KW  - hyperkalemia
KW  - PRRT
KW  - NET
KW  - MAG3
Y1  - 2014
UR  - https://opus.bibliothek.uni-wuerzburg.de/frontdoor/index/index/docId/12496
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:20-opus-124963
VL  - 4
IS  - 74
ER  -